Évolution spatio-temporelle du réseau de galeries chez le polychète Nereis virens (Sars) en relation avec la densité

In burrowing species, burrowing behaviour sometimes gives rise to the establishment of a territory. The spatio–temporal evolution of tunnels in the Polychaete Nereis virens (Sars) allowed us to study space allocation between individuals under two conditions of population density. During the first 3 days, a behaviour of exploration–construction within the substrate is observed. At that point, the tunnel has many branches and is a complex system of ramifications. On the 7th day, the system is simplified. The fluctuations of the various structural parameters of the burrow indicate alternating phases of activity in the animal. The shape and size of the burrow are density dependent. When the density is low, the burrow is U-shaped, whereas it is I-, L-, or Y-shaped at high density. The structure of the burrows, as observed in resin casts in the laboratory, and the absence of connections between the burrows indicate the onset of a territorial behaviour within the sediment right at the beginning of construction.[Journal translation]

[Comparison between myocardial perfusion scintigraphy with thallium-201 and technetium-99m-Sestamibi (methoxy isobutyl isonitrile) for the detection of coronary atherosclerotic disease]

99mTc-SESTAMIBI is a new myocardial perfusion agent used in the detection of atherosclerotic coronary artery disease. In the present study, myocardial scintiscanning (on treadmill) with 99mTc-SESTAMIBI and 201-Thallium were compared, and both were compared with coronary angiography. Some 130 consecutive patients were evaluated within an interval of a few weeks with scintiscans of both 99mTc-SESTAMIBI and 201-Thallium: 82 of them were also examined by coronary angiography. Segmental analysis of the two series of scans revealed some correlation in 89.2% of the segments, while correlation of the final diagnosis showed agreement in 92% of cases. Compared to coronary angiography, sensitivity in the detection of CAD was found to be 75.8% for 201-Thallium and 72.5% for 99mTc-SESTAMIBI. The authors conclude that 99mTc-SESTAMIBI is a promising myocardial perfusion agent which displays an excellent correlation with 201-Thallium.

Correlation of chromosome abnormalities with laboratory features and clinical course in B-cell chronic lymphocytic leukaemia

141 patients with B-cell chronic lymphocytic leukaemia (B-CLL) have been studied for a minimum of 12 months and a maximum of 25 years. 30 of 133 patients (32.5%) had greater than 10% FMC7 positive peripheral blood lymphocytes and 19 of 131 patients (14.5%) had a serum or urinary paraprotein. At presentation 88 patients were stage A0, 18 A1, 18 A2, 11 B and six C. 44 (31%) had progressive disease and 42 (30%) died during the study period. 63 patients had a normal karyotype, 75 a clonal abnormality and in three no metaphases were obtained. The finding of a complex karyotypic abnormality was significantly associated with lambda surface phenotype (P less than 0.01), the presence of greater than 10% FMC7 positive cells (P less than 0.025), and the presence of a paraprotein (P = 0.025). Patients whose leukaemic cells had a complex karyotype and those with structural abnormalities of chromosomes 14 and 6 required treatment earlier than those with a normal karyotype.

Response to calcium of skinned gallbladder smooth muscle from newborn and adult guinea pigs

Guinea pig gallbladder smooth muscle contractility undergoes a period of postnatal maturation. Because tissues from adult animals contract more forcefully than tissues from newborn animals when stimulated with agonists that activate the contractile process through different mechanisms (receptor activation, membrane depolarization), we proposed that factors unrelated to the mechanism of action of the agonist may contribute to the difference in force development between the age groups. Our study tested this hypothesis by examining the in vitro contractile response to calcium of membrane skinned muscle preparations from newborn and adult guinea pigs. Cell membranes were permeabilized using a Triton X-100 (0.5%) skinning solution. The muscle strips were rinsed in relaxing solution then contracted with calcium. The contracting solution contained either 1, 5, 10, or 20 microM calcium. Each muscle strip was stimulated with a single concentration of calcium. The results can be summarized as follows: 1) the maximal response of the skinned preparations did not differ from that of membrane intact preparations; 2) tissues from each age group contracted in a dose-response manner with the maximal response occurring at 10 microM calcium; and 3) at each calcium concentration, tissues from adult animals developed more active force than tissues from newborn animals. The data suggest that the postnatal maturation of gallbladder smooth muscle contractility includes factors involved in calcium activation of the excitation-contraction coupling process.

Pediatric cerebrovascular disease. Alterations of regional cerebral blood flow detected by TC 99m-HMPAO SPECT

Regional cerebral blood flow (rCBF) alterations, as determined by single photon emission computed tomography (SPECT) using technetium Tc 99m hexamethyl propylenamine oxime (Tc 99m-HM-PAO), were studied in 15 infants and children presenting with cerebrovascular disorders between the ages of 2 weeks and 16 years. The rCBF patterns were correlated with clinical presentation, electroencephalographic patterns, radiologic studies, including computed tomography and magnetic resonance imaging of the head, and cerebral angiography. All patients presented with motor weakness that was accompanied in some with dysphasia, defects in visual fields, obtundation, seizures, and high temperature. Perturbations of rCBF with Tc 99m-HMPAO SPECT brain scanning were detected in all patients investigated, with no adverse effects related to the radiotracer. All patients had a focal area of decreased rCBF, with adjacent hyperemia in 3 patients. In 7 patients, there was an rCBF decrease in a vascular distribution, mainly that of the middle cerebral artery, that correlated with the clinical findings and a focal electroencephalogram, as well as computed tomography and magnetic resonance imaging of the head. Impairment of rCBF was more extensive in 3 children, while early abnormal SPECT findings preceded abnormal computed tomographic findings in another 2 children. In 2 patients, Tc 99m-HMPAO SPECT was the only positive radiologic test to correlate with focal clinical and electroencephalographic abnormalities, in view of repeated normal computed tomographic scans. We conclude that Tc 99m-HMPAO SPECT brain scanning is a sensitive, complementary diagnostic measure in the early detection, localization, and estimation of rCBF alterations in pediatric cerebrovascular disease.

Return to work after rehabilitation following traumatic brain injury

The relationship of medical variables and discharge functional status to vocational and educational outcomes was examined in 79 closed head-injured patients who were consecutively admitted to an inpatient rehabilitation hospital during a two-year period. A follow-up study, conducted after hospital discharge (median, 16.5 months), found that 66% (n = 52) of the patients had returned to work or school, while 34% (n = 27) did not. Patients were divided into return and non-return to work groups. Traditional variables included age, severity of brain-damage as characterized by CT head scan, duration of post-traumatic amnesia, duration of coma, length of stay and acute inpatient rehabilitation program. Discharge functional scores were analysed by t-tests and chi-square analysis. Results suggest that traditional factors of younger age, shorter length of coma, minimal CT head scan findings and shorter length of stay were significant contributors to educational/vocational outcome. Their significance was enhanced by discharge functional profile measurement of medical, physical and psychological/neuropsychological integrity. Those functional measures not significant were in social, vocational, recreational and communication areas. These factors may continue to improve over a longer period of time and should be tracked in the post-acute rehabilitation phase for their significance in return to work/school.

Therapeutic upper gastrointestinal endoscopy. Past, present, and future

Therapeutic procedures in upper gastrointestinal endoscopy are usually performed with the patient under sedation, and there is a clear advantage with video endoscopy. The endoscopy assistant needs full training on the appropriate and safe use of equipment and accessories. Complications of procedures should be detected early and managed appropriately. Indications, results, and perspectives of endoscopic procedures are reviewed for the following situations: gastrointestinal bleeding, caustic injury, foreign bodies, advanced and superficial cancer, dysplasia, reflux esophagitis, motility disorders, and nutritional assistance. Consolidation of current methods and systematic evaluation of the results of therapeutic endoscopy are important tasks for the near future.

[Endosonography in gastroenterology. Update in 1989]

Endosonography consists of exploring the gastrointestinal wall and surrounding tissue with the aid of an ultrasound transducer introduced into the gastrointestinal lumen. High frequency ultrasound (more than 7 MHz) is used and provides high definition imaging. Its principal role is in oncology, and more particularly in the assessment of tumor extension. Regardless of whether it is the rectum, esophagus or stomach being considered, it is possible to predict the depth of tumor invasion in the wall in more than 80% of cases. The determination of invasion of adjacent organs is still somewhat imprecise. Endosonography provides better analysis of lymph nodes than CT scan (70 to 75% precision) and improvements will occur with better description of the criteria of malignancy. It appears interesting for the evaluation of pancreatic and biliary tumors and for follow-up of patients already treated for gastrointestinal cancer. Among its other indications, some have been well established (gastrointestinal submucosal tumors, giant gastropathy) and others require confirmation (villous tumors of the rectum, gastric ulcer).

Gallstone disappearance after extracorporeal lithotripsy and oral bile acid dissolution

Extracorporeal shock-wave cholelithotripsy was carried out in 135 symptomatic patients with radiolucent gallstones, followed by oral bile acid dissolution to assess the resultant stone disappearance rates. Fragmentation was satisfactory (all fragments less than 5 mm in diameter) in 34 patients (25%) after a single session of lithotripsy, and in 65 (48%) after multiple sessions. The overall satisfactory fragmentation rate was significantly higher in patients with single stones less than or equal to 20 mm in diameter when compared with those with larger solitary stones (71% vs. 38%, p less than 0.05), as it also was in all subjects with solitary stones when compared with those with multiple stones (60% vs. 34%, p less than 0.05). After 6, 9, and 12 mo of oral bile acid treatment, the stone-free rates were significantly higher in patients with satisfactory than in those with partial fragmentation (55% vs. 0%, 80% vs. 29%, and 90% vs. 33%, respectively; p less than 0.05). Only 1 of the 7 patients who had previously undergone endoscopic sphincterotomy for concomitant choledocholithiasis was free of stones after 1 yr of dissolution. During dissolution therapy, of the 102 patients in whom fragmentation had occurred, 1 (1%) developed mild acute pancreatitis, 23 (23%) suffered attacks of biliary colic, and 6 (6%) required cholecystectomy. We conclude that the result of fragmentation appears to be a major determinant of the success and rapidity of subsequent oral bile acid dissolution, and that when satisfactory, it allows for complete stone disappearance in most patients within the following year. A comparison of the present results with those of previous original studies suggests that to achieve such satisfactory fragmentation, patients should be selected on the basis of their stone characteristics, which optimally should present as solitary gallbladder calculi less than 20 mm in diameter. Furthermore, real-time ultrasonographic monitoring should be used during lithotripsy with a transducer centered along the shock-wave axis. Despite the innocuousness of the shock waves, the incidence of fragment migration and its possible complications, in our experience, emphasizes the need to restrict at present this nonoperative approach to the treatment of symptomatic gallstone disease.

Contribution of endoscopy to diagnosis and treatment of tumors of the ampulla of Vater

In a series of 52 patients presenting with tumors of the ampulla of Vater, endoscopic procedures, especially endoscopic sphincterotomy and snare biopsies, permitted histologic classifications as follows: adenocarcinoma: 50%, adenoma: 35%, and adenoma with cancer: 15%. In 37% of cases, the papilla was normal endoscopically and the tumor was detected only after sphincterotomy. Destruction of adenomas by snare resection, laser photoradiation, or both after sphincterotomy was attempted in 11 patients. Subsequent biopsies revealed persistence or recurrence of adenomatous tissue in only one case and complete destruction of adenomas, with a mean duration of follow-up of 39 months, in the 10 other cases. Palliative treatment by endoscopic procedures was performed in 21 patients and was effective for a mean of 45 months for adenomas and for a mean of 6 months for adenocarcinomas, with a mortality of 10%. To avoid repeated sphincterotomy in patients requiring palliative treatment, the data support the early use of endobiliary prostheses. Endoscopic palliative treatment is not indicated, however, for infiltrative tumors that can induce rapid duodenal obstruction.

Contribution of endoscopy to diagnosis and treatment of tumors of the ampulla of Vater

In a series of 52 patients presenting with tumors of the ampulla of Vater, endoscopic procedures, especially endoscopic sphincterotomy and snare biopsies, permitted histologic classifications as follows: adenocarcinoma: 50%, adenoma: 35%, and adenoma with cancer: 15%. In 37% of cases, the papilla was normal endoscopically and the tumor was detected only after sphincterotomy. Destruction of adenomas by snare resection, laser photoradiation, or both after sphincterotomy was attempted in 11 patients. Subsequent biopsies revealed persistence or recurrence of adenomatous tissue in only one case and complete destruction of adenomas, with a mean duration of follow-up of 39 months, in the 10 other cases. Palliative treatment by endoscopic procedures was performed in 21 patients and was effective for a mean of 45 months for adenomas and for a mean of 6 months for adenocarcinomas, with a mortality of 10%. To avoid repeated sphincterotomy in patients requiring palliative treatment, the data support the early use of endobiliary prostheses. Endoscopic palliative treatment is not indicated, however, for infiltrative tumors that can induce rapid duodenal obstruction.

Contribution of endoscopy to diagnosis and treatment of tumors of the ampulla of Vater

In a series of 52 patients presenting with tumors of the ampulla of Vater, endoscopic procedures, especially endoscopic sphincterotomy and snare biopsies, permitted histologic classifications as follows: adenocarcinoma: 50%, adenoma: 35%, and adenoma with cancer: 15%. In 37% of cases, the papilla was normal endoscopically and the tumor was detected only after sphincterotomy. Destruction of adenomas by snare resection, laser photoradiation, or both after sphincterotomy was attempted in 11 patients. Subsequent biopsies revealed persistence or recurrence of adenomatous tissue in only one case and complete destruction of adenomas, with a mean duration of follow-up of 39 months, in the 10 other cases. Palliative treatment by endoscopic procedures was performed in 21 patients and was effective for a mean of 45 months for adenomas and for a mean of 6 months for adenocarcinomas, with a mortality of 10%. To avoid repeated sphincterotomy in patients requiring palliative treatment, the data support the early use of endobiliary prostheses. Endoscopic palliative treatment is not indicated, however, for infiltrative tumors that can induce rapid duodenal obstruction.

Contribution of endoscopy to diagnosis and treatment of tumors of the ampulla of Vater

In a series of 52 patients presenting with tumors of the ampulla of Vater, endoscopic procedures, especially endoscopic sphincterotomy and snare biopsies, permitted histologic classifications as follows: adenocarcinoma: 50%, adenoma: 35%, and adenoma with cancer: 15%. In 37% of cases, the papilla was normal endoscopically and the tumor was detected only after sphincterotomy. Destruction of adenomas by snare resection, laser photoradiation, or both after sphincterotomy was attempted in 11 patients. Subsequent biopsies revealed persistence or recurrence of adenomatous tissue in only one case and complete destruction of adenomas, with a mean duration of follow-up of 39 months, in the 10 other cases. Palliative treatment by endoscopic procedures was performed in 21 patients and was effective for a mean of 45 months for adenomas and for a mean of 6 months for adenocarcinomas, with a mortality of 10%. To avoid repeated sphincterotomy in patients requiring palliative treatment, the data support the early use of endobiliary prostheses. Endoscopic palliative treatment is not indicated, however, for infiltrative tumors that can induce rapid duodenal obstruction.

Retrograde biliary ultrathin endoscopy enhances biopsy of stenoses and lithotripsy

Forceps biopsies of biliary stenoses are difficult to direct under fluoroscopy and for this reason may give spurious results. In addition, fluoroscopy does not prevent the electrohydraulic lithotripsy (EHL) probe from damaging the bile duct wall. Retrograde biliary endoscopy with the ultrathin endoscope (UTE) was tested in 12 patients to guide biopsies and in 6 patients to guide EHL. Results of biopsies were confirmed by surgery or the disease course in each of the 12 patients. Only one stone could not be fragmented and removed because the EHL probe could not be properly placed. The diagnosis of biliary stenosis may be markedly enhanced by using a UTE although at the risk of an endoscopic sphincterotomy and subsequent biliary infection. EHL with UTE is difficult and time consuming but further technical development may make it more practical immediately following sphincterotomy.

Clinical comparison between thallium-201 and Tc-99m-methoxy isobutyl isonitrile (hexamibi) myocardial perfusion imaging for detection of coronary artery disease

99mTc-hexamibi (methoxy isobutyl isonitrile) is a new 99mTc-hexakis analog that can be used as a myocardial perfusion imaging agent. The purposes of this study were to compare 99mTc-hexamibi to 201Tl-thallous chloride myocardial stress scintigraphy in patients referred for investigation of chest pain and to evaluate the sensitivity of 99mTc-hexamibi in detection of coronary artery disease. One hundred patients were prospectively studied with both 201Tl and 99mTc-hexamibi planar imaging. Sixty five patients had a current coronary angiography. There was a total of 97 significantly (less than or equal to 70%) stenosed major coronary arteries. 99mTc-hexamibi (25 mCi) study was done within a week of the 201Tl scan with similar double products upon standard treadmil stress testing. Rest studies with 99mTc-hexamibi were obtained 24-48 h after the stress test using the same acquisition parameters and dose. Analysis was performed blind by three observers. The left ventricle was divided into five segments in each image. Analysis of 201Tl and 99mTc-hexamibi results in 1500 left ventricle segments showed an overall agreement in 1326/1500 (88.4%) segments. Correlation between the patient diagnosis on the 201Tl and 99mTc-hexamibi studies showed an agreement in 89 patients (89%). 201Tl revealed myocardial uptake defects in 526 segments, detecting 72 out of 97 (74.2%) significantly stenosed coronary arteries and 99mTc-hexamibi detected 513 segments corresponding to 68 (70.1%) stenosed arteries (no significant statistical difference). In conclusion, these results show a good correlation between 201Tl and 99mTc-hexamibi myocardial imaging in the detection of significant coronary artery disease.

Lymphocytic gastritis versus varioliform gastritis. A historical series revisited

A historical series of varioliform gastritis published in 1978 by Lambert et al. (Digestion 1978; 17: 159-167) was revisited by two pathologists. The histological preparations from 35 patients were reread and interpreted in the light of endoscopic data found in the files. The results demonstrate a strict correlation between clinical diffuse varioliform gastritis and a recently recognized histopathological entity--lymphocytic gastritis, which is characterized by intense lymphocytic infiltration of the surface and foveolar epithelium. The rare discrepancies occur in Crohn's disease and in varioliform gastritis limited to part of the stomach, mostly the antrum.

Esophageal squamous cell carcinoma associated with gastric adenocarcinoma

Adenocarcinoma of the stomach occurred in six of 425 consecutive patients with esophageal squamous cell cancer. In two cases, the gastric cancer, which was recognized at 17 and 29 months, respectively, after the nonsurgical treatment of the esophageal tumor, was treated by surgical resection. In three cases, the tumors which were diagnosed simultaneously, were treated by surgery (one case) resection of the gastric tumor and nonsurgical therapy for the esophageal tumor (one case), and nonsurgical therapy for both tumors (one case). In one case, a gastric cancer was resected 6 years before diagnosis of an esophageal tumor and a second cancer in the gastric stump. A nonsurgical protocol was then adopted for both tumors. The association of these two cancers raises questions concerning their epidemiology, diagnosis, prognosis, and management. There is room for nonsurgical multimodality protocols and, in association with surgery, survival was prolonged for more than 1 year in five of six patients.

Percutaneous aspiration and drainage of hydatid cysts in the liver

Percutaneous aspiration of hydatid cysts of the liver was performed in 13 patients, and subsequent percutaneous drainage was performed in three of the 13. Aspiration was performed with ultrasound or computed tomographic guidance with 22-gauge to 19-gauge needles. Analysis of the aspirated specimen established the diagnosis of hydatid cysts in nine of the 13 patients. Fragments of the laminated membrane were seen in seven cases, scolices in two cases, and hooklets in two cases. In the four cases with negative results on aspiration, the diagnosis was established with surgical findings in one case and unequivocal immunologic results in three cases. In two patients, a mild allergic reaction with temporary pruritus was observed. In three patients, percutaneous drainage was performed with a 5-F to 8.3-F catheter, and sterilization of the cyst was achieved by injection of a scolicidal agent. No complications occurred at the time of drainage, and no recurrences developed during 6 months to 1 year after drainage.

Laser treatment of tumors of the papilla of Vater

Tumors of the papilla of Vater, should be separated from periampullary tumors. They are not always malignant, and recent data from endoscopy series, and pathology studies, supports the adenoma-carcinoma sequence at this level. Adenomas are tubular or villous and are classified according to the degree of dysplasia. The endoscopic pattern separates exophytic tumors, sessile and easily detected, from intracanalar tumors usually detected after sphincterotomy. The malignancy of an exophytic tumor is suspected when it is ulcerated or large (over 3 cm), and is easily confirmed by biopsies. The typing of intracanalar tumors is more difficult. In a 5-year period, an ampullary tumor was detected by ERCP in 52 patients: the tumor was exophytic in 33 and intracanalar in 19. Adenocarcinoma was confirmed in 26 and adenoma in 26, resulting in a 50% ratio. Among the adenomas, 18 were fully benign and 8 had a superficial cancer focus. Therapeutic procedures included: laser photodestruction in 16, snare resection in 16, sphincterotomy in 47, stenting in 8, surgical bypass in 7, cephalic duodenopancreatectomy in 16. The 16 patients treated by laser (Nd:YAG mainly) included 8 adenomas: a complete tumor destruction was obtained in 7 (follow up from 14 to 53 months). Adenomatous recurrence was observed at 2 years in one patient. In 8 other patients the tumor was an adenocarcinoma; Laser photodestruction failed to completely destroy the tumor in 1 patient (operative control), in 7 others it was adopted as a complement to sphincteromy and stenting in palliation, but was not found very effective.(ABSTRACT TRUNCATED AT 250 WORDS)

[Ultrasonoendoscopy: its indications in esophageal and gastric pathology]

Endoscopic ultrasonography (EUS), which uses a high sonographic frequency (7.5 mHz) is a recently developed diagnostic tool that enables detailed analysis of the digestive wall and visualization of adjacent structures, like the posterior mediastinum through the esophagus. Thus, EUS may provide accurate documentation of the extent of esophagogastric malignancies, and of the adjacent lymph-node involvement. From now, results in preoperative staging compare favourably with CT scan. EUS provides also helpful complementary informations for the diagnosis of giant fold gastropathies or submucosal (or extrinsic) abnormalities. Moreover it may be usefull for the post-therapeutic follow-up of cancers, ulcers or varices.

Obstructive hydrocephalus-induced parkinsonism. I: Decreased basal ganglia regional blood flow

A 17-year-old male developed acute parkinsonism after obstruction of a ventriculoperitoneal shunt with subsequent hydrocephalus. Following a previous shunt replacement, he developed florid parkinsonism which was associated with Parinaud syndrome. The initial single-photon emission computed tomography of the brain using 99mTc-hexamethylpropylenamine oxime demonstrated decreased cerebral blood flow in the regions of the left caudate and putamen. The patient underwent shunt revision with minimal improvement and therefore levodopa/carbidopa (Sinemet 100/25) was administered. Subsequently, he experienced almost complete recovery which may have been correlated with probable improvement of the basal ganglia regional cerebral blood flow. Parkinsonism associated with ventriculoperitoneal shunt obstruction is a rare but reversible disorder that is responsive to shunt replacement and antiparkinsonian drug administration. Cerebral perfusion studies may prove to be of value in delineating the pathophysiology of this complication.

Eurotium spp. and echinulin in feed refused by swine

Feed refused by swine contained a high-propagule density of Eurotium chevalieri Mangin (anamorph, Aspergillus chevalieri (Mangin) Thom and Church), Eurotium amstelodami Mangin (anamorph, Aspergillus amstelodami (Mangin Thom and Church), and Aspergillus candidus Link. Echinulin (8 micrograms/g of feed) was detected in the feed. Isolates of E. chevalieri and E. amstelodami but not A. candidus produced echinulin on rice or cracked corn. Mice refused to drink water containing 90 micrograms of echinulin per ml. This is the first report of the alkaloid echinulin in feed refused by swine.

Conjugated and unconjugated C-21, C-19 and C-18 steroid concentrations in human follicular fluid from hyperstimulated follicles

Concentrations of unconjugated and glucuronated C-21, C-19 and C-18 steroids have been measured in follicular fluid obtained from women hyperstimulated by a combination of clomiphene citrate, pergonal and hCG. Pregnenolone and its glucuronide are found at approximately 5% of the progesterone values (14,395 +/- 2300 ng/ml). Concentrations of dehydroepiandrosterone glucuronide, androst-5-ene-3 beta, 17 beta-diol glucuronide, dihydrotestosterone glucuronide, androstane-3 alpha, 17 beta-diol glucuronide and androstane-3 beta, 17 beta-diol glucuronide are 2-6-fold higher than those of the related unconjugated steroids, while testosterone glucuronide levels are lower than those of testosterone. The concentrations of androsterone glucuronide reach almost 30-fold those of androsterone (2.56 +/- 0.35 ng/ml). By contrast, estradiol and estrone concentrations are 10-20-fold higher than those of conjugated steroids. Measurement of plasma steroid glucuronides indicated that the concentrations in circulation are markedly lower than those detected in follicular fluid. Our data suggest that the ovary in humans may be a site of glucuronidation.

[Laser treatment of villous rectal tumors]

The treatment of villous rectal tumors with the Nd: YAG laser is characterized by its great effectiveness (almost 90% of complete eradication in our series of 100 cases), and by its great tolerance. It may be applied to all patients regardless of their condition. In case of running villous tumors, complete destruction is more difficult to obtain and the laser method must be weighed against the risks and advantages of radical surgery. The problems raised by frequent foci of adenocarcinoma, which characterize large villous lesions, is minimized by a strict therapeutic protocol: in fact, the foci are superficial in the majority of the cases and they do not decrease the percentage of complete destruction; in other cases, it is possible, by repeated histological controls, in case of persisting positive biopsies, to modify, in time, the choice of treatment.

Binding and Peroxidative Action of Oxyfluorfen in Sensitive and Tolerant Algal Species

Peroxidative activity of oxyfluorfen and binding of this nitrodiphenyl ether to cell fractions was investigated with the susceptible alga Scenedesmus acutus and the resistant alga Bumilleriopsis filiformis. Although a 10-fold higher concentration of oxyfluorfen was applied to Bumilleriopsis, the lag phase for initiation of peroxidative evolution of short-chain hydrocarbons from fatty acids was much longer than found with Scenedesmus. Oxyfluorfen was predominantly recovered after homogenization from the pellet which was separated into a lipid and a chloroform/methanol insoluble fraction. Parts of the oxyfluorfen which is present in the insoluble pellet fraction during the lag phase before the onset of peroxidation can be found in the lipid fraction when measurable peroxidative activities have started. This was observed with Scenedesmus as well as with Bumil-leriopsis. During peroxidation initiated by oxyfluorfen acyl lipids are degradated as monitored by the disappearance of the plastidic sulfolipid. Analysis of bound fatty acids showed that they are targets for peroxidative reactions in acyl lipids. Destruction of polyunsaturated fatty acids was higher than for saturated ones.

Malpractice in the emergency room: a critical review of undiagnosed appendicitis cases and legal actions

A review of 1,400 potentially compensable events on file at a major insurer of hospitals in Pennsylvania demonstrated 22 cases of missed appendicitis. Each case was reviewed by three health care professionals, using standard criteria for physical examination of the abdomen as published in generally accepted text books. These cases were gleaned from a population of over 27,000,000 emergency room visits. The typical patient presented less than 24 hours after onset of symptoms. All had major elements of the history or physical examination that strongly suggested the pos sible diagnosis of appendicitis. Common elements that led to the failure to diagnose were cursoriness of examination as evidenced by documentation of the physical examination and inadequacy of follow-up and misinterpretation of existing signs and symp toms. Remedial actions are suggested.

Localized hypertrophic osteoarthropathy due to arterial graft sepsis from an enteroprosthetic fistula

The case of a 73-year-old man with localized left-lower-limb hypertrophic osteoarthropathy in association with aortic left-iliac-artery bypass and enteroprosthetic fistula was studied. The patient presented first with massive gastrointestinal bleeding and with pain and swelling of his left leg. He was hospitalized on numerous occasions for recurrent episodes of bacteremia involving enteric flora; hypertrophic osteoarthropathy and aortoduodenal fistula were documented before surgery. Symptoms and signs of hypertrophic osteoarthropathy were markedly alleviated after removal of the infected prosthesis. A review of the literature revealed seven additional patients with a similar presentation. The diagnosis of infected arterial graft with enteroprosthetic fistula may be extremely difficult, and a delay in this diagnosis may be lethal. Awareness of this uncommon association may lead to prompt diagnosis and early surgical therapy.

Glomerular epithelial cell lesions in rat renal isografts

Visceral glomerular epithelial cell lesions--microvillus formation, loss of foot processes, osmiophilic inclusion droplets, balloon-like malformation of cell processes, degeneration, necrosis, and loss of cell processes from capillary basement membranes--are found in rat renal isografts 1 mth after transplantation. The lesions, which are most readily recognized in perfusion-fixed material, are essentially focal, affecting neither all glomeruli, nor all cells in any glomerulus, bear no relation to the degree of interstitial nephritis in the graft, and are associated with albuminuria and with focal capillary sclerosis in some glomeruli. They are not restricted to renal isografts but are found in aging rats, in different experimental models of glomerular disease and in clinical glomerular disorders, again in association with proteinuria and glomerulosclerosis. It is therefore proposed that glomerular epithelial cell damage increases capillary permeability and impairs maintenance of the integrity of the capillary wall, leading to proteinuria and focal glomerulosclerosis.

Glomerular damage after kidney preservation

Severe proteinuria occurs during isolated organ perfusion of kidneys removed from SD and DA rats and subjected to 24-hr cold preservation. In both strains increased glomerular permeability was associated with changes in glomerular visceral epithelial cells, particularly cytoplasmic edema and detachment of cells from capillary basement membranes. Foot processes were intact and staining for sialoglycoprotein was retained. The changes were compatible with survival of the isograft kidney after transplantation, but moderate proteinuria was found in some rats after one month. Protein loss in the urine during isolated organ perfusion is very much less in kidneys subjected to 4-hr cold preservation, and the glomerular epithelial cells are normal or show only minimal cytoplasmic edema on electron microscopy. The experiment shows that significant damage to glomeruli may occur during preservation prior to transplantation, and the model itself can be usefully exploited to determine the relation between increased glomerular permeability to albumin and the associated changes in the glomerular capillary wall.

Occurrence of a nucleoprotein bound RNase in rat brain and liver

An RNase activity was found to be present in rat brain and liver and was strongly bound to the nucleoprotein fractions of these tissues. It could not be solubilized by treatment with acid or by lipid solvents. The pattern of oligonucleotides produced during hydrolysis by this enzyme indicated that it was probably an endonuclease with restricted specificity. It was inhibited by zinc ions and by low pH.

Gallium-67 uptake in the lung of asbestos exposed sheep: early association with enhanced macrophage-derived fibronectin accumulation

To evaluate the time course and mechanisms of enhanced 67Ga lung uptake in asbestosis, we exposed two groups of sheep every 2 wk to either 100 ml saline (controls) or 100 mg UICC chrysotile fibers in 100 ml saline. The sheep were evaluated periodically by pulmonary function tests (PFT), thoracic radiograph (TR), 67Ga lung scan bronchoalveolar lavage (BAL), and transbronchial lung biopsy (TLB). By month 24 of the study, 9/15 exposed sheep had developed the initial alveolitis and had significant changes in PFT, TR, and TLB. The other six exposed sheep differed from controls only by a 75% increase in BAL fibronectin until month 30, where significant changes in albumin occurred and 67Ga scan score increased. The nine sheep with alveolitis had significant sustained increases in 67Ga scan and BAL levels from month 6, associated with a 150% increase in BAL fibronectin and other parameters of disease activity changed from month 18 to 30. We concluded that in the sheep model of asbestosis, significant changes in 67Ga scan, 67Ga BAL counts, and excessive elevation of BAL fibronectin preceded other parameters of disease activity. The data suggest that excessively activated macrophages are primarily responsible for the early 67Ga lung uptake.

[A triple association: rectocolonic adenomatosis, gastroduodenal polyposis and secreting adrenocortical adenoma]

A case of adenomatosis coli, gastroduodenal polyps, and functional adrenocortical adenoma in a 28 year-old woman is reported. The association of cystic fundic gland polyposis and duodenal adenomatosis was demonstrated endoscopically. The particular point of interest in this case report is the functional nature of the adrenocortical adenoma. Endocrine tumors associated with adenomatosis coli are generally discovered at autopsy. No similar case has been previously published.

Memory formation in birds: 1. Avoidance conditioning of the budgerigar (Melopsittacus undulatus) to sound stimuli

A system is described for avoidance conditioning of the budgerigar (Melopsittacus undulatus), for sound patterns consisting of one or two sequential subunits and to discriminate between two closely resembling sounds. Electric shock was used as the unconditioned stimulus. Simple conditioning was accomplished in about 300-400 trials. After a given sound pattern was firmly fixed by conditioning, discrimination between this and a new sound pattern was established relatively rapidly by using several consecutive sessions in which the two patterns were mixed. Discrimination was reinforced by associating the two signals by opposing electric shocks. An overnight rest period after the first few sessions improved the rate of conditioning during the following experimental period. A temporary, partial or complete extinction of conditioning was produced by longer rest intervals, but the original conditioning was reestablished by subjecting the animal to a few trials of reconditioning. Short intercalations of a new conditioned stimulus had no effect on the retention of the original conditioning whereas a random mixing of the first conditioned stimulus with a second produced a temporary decay in the original conditioning. The experimental system described here is useful for studying physiological and biochemical changes accompanying a memory process based on a linear sequence of sound patterns.

Memory formation in birds: 2. Effects of stress due to experimental procedures on the conditioning of the budgerigar (Melopsittacus undulatus) to sound stimuli

Conditioning studies involving administration of biochemical or pharmacological agents are often stressful to experimental animals. Some of these stressful manipulations were examined for their effect on the avoidance conditioning of the budgerigar to sound stimuli. There were individual variations in the capacity of the birds to accommodate to these stresses, but generally the stress factors had negative effects on their subsequent conditioning, the degree of this effect depending upon the type and severity of stress. Simple anesthesia with ether had the least effect, intravenous injection being next in severity, while intracerebral injection was most inhibitory. The effects due to anesthesia and intravenous injection could be decreased by delaying the conditioning procedure for 1 to 2 hours following the treatment, but the effect of intracerebral injection was more prolonged. The retrieval of temporarily lost conditioned response through brief reconditioning was not affected by intracerebral injection, indicating that, once a memory trace was formed, subsequent emotional and physical stresses did not obliterate it irreversibly.

Gallium-67 thoracic scan and pleural disease in asbestos workers

We have recently reported that 67Ga scanning in asbestos workers can document excessive uptake of the marker among workers without sufficient criteria for asbestosis, but in our initial report we could not exclude definitely that 67Ga uptake could be related to pleural disease. To further test this hypothesis, we analyzed the 67Ga thoracic scan in relation to profusion scores of pleural disease on chest roentgenogram and CT scan of the thorax in 171 asbestos workers. We found no significant correlation between the 67Ga lung uptake and the radiographic scores of pleural disease. We concluded that pleural plaques are not an active site of 67Ga accumulation and do not contribute significantly to the thoracic uptake of the marker.